What is AERD/Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
What are the symptoms?
Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.
These reactions can include:
- Increased nasal congestion or stuffiness
- Eye watering or redness
- Cough, wheezing, or chest tightness
- Frontal headache or sensation of sinus pain
- Flushing and/or a rash
- Nausea and/or abdominal cramping
- General feeling of malaise, sometimes accompanied by dizziness
If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.
As the director of one of the largest evaluation and treatment centers for patients with AERD in the world, Dr. Laidlaw is often asked how to approach the use of aspirin desensitization followed by high-dose aspirin therapy for patients with AERD in the current age of newly available biologics. In this perspective article, she describes a place for both treatment modalities, sometimes even both in the same patient at the same time. It is a set of decisions that need to be made on an individual patient basis — efficacy, safety, cost, and patient preference should be considered when approaching the decision and recommendation.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common and heterogeneous inflammatory disease of the upper respiratory tract. Advances in our understanding of the immune mechanisms that drive the chronic respiratory inflammation that underlies CRSwNP have led to the generation of several targeted biologic therapies for this disease. However, the optimal evaluation and treatment strategy, including judicious use of systemic corticosteroids, allergen testing, proper surgical approach, appropriateness of antibiotics, and administration of newly approved biologics, is still hotly debated. Here we provide expert opinion and points of view from both allergists and rhinologists who specialize in CRSwNP, and the evaluation and management perspectives offered here are a consensus between the authors. Special consideration is given to patients with AERD, as they are a unique phenotype who often have the most severe disease symptoms. Read here.
We studied the patient-reported symptoms (SNOT-22 scores and ACT scores) and lung function (FEV1) of 1065 patients with AERD in our AERD Patient Registry. SNOT-22 scores significantly predict ACT scores and FEV1%, and ACT scores significantly predict FEV1%. Any ten-point increase in SNOT-22 was associated with a 0.87-point decrease in ACT and a 0.75% decrease in FEV1%. Any one-point increase in ACT was associated with a 1.0% increase in FEV1%. The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity, and confirms that the two symptoms that generally are the both bothersome to our patients are loss of smell and nasal congestion. Read here.